Dehydration: Wikis

  
  
  

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Dehydration
Classification and external resources
ICD-10 E86.
ICD-9 276.5

Dehydration (hypohydration) is defined as an excessive loss of body fluid. It is literally the removal of water (Ancient Greekὕδωρ hýdōr) from an object, however in physiological terms, it entails a deficiency of fluid within an organism.

There are three main types of dehydration: hypotonic (primarily a loss of electrolytes, sodium in particular), hypertonic (primarily a loss of water), and isotonic (equal loss of water and electrolytes).[1] In humans, the most commonly seen type of dehydration by far is isotonic (isonatraemic) dehydration which effectively equates with hypovolemia, but distinction of isotonic from hypotonic or hypertonic dehydration may be important when treating people who become dehydrated. Physiologically, it is important to understand that dehydration, despite the name, does not simply mean loss of water, as water and solutes (mainly sodium) are usually lost in roughly equal quantities to how they exist in blood plasma.

Contents

Difference from hypovolemia

Hypovolemia is specifically a decrease in volume of blood plasma.[2][3] Furthermore, hypovolemia defines water deficiency only in terms of volume rather than specifically water.

Nevertheless, the conditions usually appear simultaneously.

Medical causes of dehydration in humans

In humans, dehydration can be caused by a wide range of diseases and states that impair water homeostasis in the body. These include:

Symptoms and prognosis

Symptoms may include headaches similar to what is experienced during a hangover, muscle cramps, a sudden episode of visual snow, decreased blood pressure (hypotension), and dizziness or fainting when standing up due to orthostatic hypotension. Untreated dehydration generally results in delirium, unconsciousness, swelling of the tongue and, in extreme cases, death.

Dehydration symptoms generally become noticeable after 2% of one's normal water volume has been lost. Initially, one experiences thirst and discomfort, possibly along with loss of appetite and dry skin. This can be followed by constipation. Athletes may suffer a loss of performance of up to 30%[5] and experience flushing, low endurance, rapid heart rates, elevated body temperatures, and rapid onset of fatigue.

Symptoms of mild dehydration include thirst, decreased urine volume, abnormally dark urine, unexplained tiredness, irritability, lack of tears when crying, headache, dry mouth, dizziness when standing due to orthostatic hypotension, and in some cases can cause insomnia. Blood tests may show hyperalbuminemia.

In moderate to severe dehydration, there may be no urine output at all. Other symptoms in these states include lethargy or extreme sleepiness, seizures, sunken fontanel (soft spot) in infants, fainting, and sunken eyes.

The symptoms become increasingly severe with greater water loss. One's heart and respiration rates begin to increase to compensate for decreased plasma volume and blood pressure, while body temperature may rise because of decreased sweating. Around 5% to 6% water loss, one may become groggy or sleepy, experience headaches or nausea, and may feel tingling in one's limbs (paresthesia). With 10% to 15% fluid loss, muscles may become spastic, skin may shrivel and wrinkle (decreased skin turgor), vision may dim, urination will be greatly reduced and may become painful, and delirium may begin. Losses greater than 15% are usually fatal.

In people over age 50, the body’s thirst sensation diminishes and continues diminishing with age. Many senior citizens suffer symptoms of dehydration. Dehydration along with hyperthermia results in seniors dying during extreme hot weather.

Diseases of the gastrointestinal tract can lead to dehydration in various ways. Often, dehydration becomes the major problem in an otherwise self-limited illness. Fluid loss may even be severe enough to become life-threatening.

Numerous studies have shown that for terminally ill patients who choose to die, deaths by dehydration are generally peaceful, and not associated with suffering, when supplemented with adequate pain medication.[6][7][8][9][10][11]

Treatment

Nurses encourage a patient to drink an Oral Rehydration Solution to improve dehydration he acquired from cholera.

The treatment for minor dehydration often considered the most effective is drinking water and stopping fluid loss. Plain water restores only the volume of the blood plasma, inhibiting the thirst mechanism before solute levels can be replenished.[12] Solid foods can contribute to fluid loss from vomiting and diarrhea. [13]

In more severe cases, correction of a dehydrated state is accomplished by the replenishment of necessary water and electrolytes (rehydration, through oral rehydration therapy or intravenous therapy). Even in the case of serious lack of fresh water (e.g. at sea or in a desert), drinking seawater or urine does not help, nor does the consumption of alcohol. It is often thought that the sudden influx of salt into the body from seawater will cause the cells to dehydrate and the kidneys to overload and shut down but it has been calculated that an average adult can drink up to 0.1 litres of seawater per day before the kidneys start to fail[citation needed]

For severe cases of dehydration where fainting, unconsciousness, or other severely inhibiting symptom is present (the patient is incapable of standing or thinking clearly), emergency attention is required. Fluids containing a proper balance of replacement electrolytes are given orally or intravenously with continuing assessment of electrolyte status; complete resolution is the norm in all but the most extreme cases.

Avoiding dehydration

Dehydration is best avoided by drinking sufficient water. The greater the amount of water lost through perspiration, the more water must be consumed to replace it and avoid dehydration. Since the body cannot tolerate large deficits or excesses in total body water, consumption of water must be roughly concurrent with the loss (in other words, if one is perspiring, one should also be drinking some water frequently).

For routine activities in which a person is not perspiring to any large degree, drinking when one is thirsty is sufficient to maintain hydration. However, during exercise, relying on thirst alone may be insufficient to prevent dehydration from occurring. This is particularly true in hot environments, or for those older than 65. For an exercise session, an accurate determination of how much fluid is necessary to consume during the workout can be made by performing appropriate weight measurements before and after a typical exercise session, to determine how much fluid is lost during the workout. [14][15][16][17][18]

Drinking water beyond the needs of the body entails little risk when done in moderation, since the kidneys will efficiently remove any excess water through the urine with a large margin of safety.

A person's body, during an average day in a temperate climate such as the United Kingdom, loses approximately 2.5 litres of water.[citation needed] This can be through the lungs as water vapor, through the skin as sweat, or through the kidneys as urine. Some water (a less significant amount, in the absence of diarrhea) is also lost through the bowels. In warm or humid weather or during heavy exertion, however, the water loss can increase by an order of magnitude or more through perspiration; all of which must be promptly replaced. In extreme cases, the losses may be great enough to exceed the body's ability to absorb water from the gastrointestinal tract; in these cases, it is not possible to drink enough water to stay hydrated, and the only way to avoid dehydration is to either pre-hydrate, [19] or find ways to reduce perspiration (through rest, a move to a cooler environment, etc.)

A useful rule of thumb for avoiding dehydration in hot or humid environments or during strenuous activity involves monitoring the frequency and character of urination. If one develops a full bladder at least every 3-5 hours and the urine is only lightly colored or colorless, chances are that dehydration is not occurring; if urine is deeply colored, or urination occurs only after many hours or not at all, water intake may not be adequate to maintain proper hydration.

When large amounts of water are being lost through perspiration and concurrently replaced by drinking, maintaining proper electrolyte balance becomes an issue. Drinking fluids that are hypertonic or hypotonic with respect to perspiration may have grave consequences (hyponatremia or hypernatremia, principally) as the total volume of water turnover increases.

If water is being lost through abnormal mechanisms such as vomiting or diarrhea, an imbalance can develop very quickly into a medical emergency.

During sports events such as marathons, water stops and water breaks are provided to avoid dehydration of athletes.

See also

References

Notes

  1. ^ TheFreeDictionary.com --> dehydration Citing The American Heritage Science Dictionary 2005. Retrieved on July 2, 2009
  2. ^ MedicineNet > Definition of Hypovolemia Retrieved on July 2, 2009
  3. ^ TheFreeDictionary.com --> hypovolemia Citing Saunders Comprehensive Veterinary Dictionary, 3 ed. Retrieved on July 2, 2009
  4. ^ Dehydration Symptoms - Benefits of Drinking Water - Signs of Fluid Imbalance
  5. ^ Bean, Anita (2006). The Complete Guide to Sports Nutrition. A & C Black Publishers Ltd.. pp. 81–83. ISBN 0713675586. 
  6. ^ Ganzini L, Goy ER, Miller LL, Harvath TA, Jackson A, Delorit MA (July 2003). "Nurses' experiences with hospice patients who refuse food and fluids to hasten death". The New England Journal of Medicine 349 (4): 359–65. doi:10.1056/NEJMsa035086. PMID 12878744. http://content.nejm.org/cgi/pmidlookup?view=short&pmid=12878744&promo=ONFLNS19. 
  7. ^ McAulay D (2001). "Dehydration in the terminally ill patient". Nursing Standard (Royal College of Nursing (Great Britain) : 1987) 16 (4): 33–7. PMID 11977821. 
  8. ^ {Van der Riet P, Brooks D, Ashby M (November 2006). "Nutrition and hydration at the end of life: pilot study of a palliative care experience". Journal of Law and Medicine 14 (2): 182–98. PMID 17153524. 
  9. ^ Miller FG, Meier DE (April 1998). "Voluntary death: a comparison of terminal dehydration and physician-assisted suicide". Annals of Internal Medicine 128 (7): 559–62. PMID 9518401. http://www.annals.org/cgi/pmidlookup?view=long&pmid=9518401. 
  10. ^ Printz LA (April 1992). "Terminal dehydration, a compassionate treatment". Archives of Internal Medicine 152 (4): 697–700. doi:10.1001/archinte.152.4.697. PMID 1373053. http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=1373053. 
  11. ^ Sullivan RJ (April 1993). "Accepting death without artificial nutrition or hydration". Journal of General Internal Medicine 8 (4): 220–4. doi:10.1007/BF02599271. PMID 8515334. 
  12. ^ "Formulating carbohydrate-electrolyte drinks for optimal efficacy." Murray, R. & Stofan, J. (2001).
  13. ^ "Healthwise Handbook," Healthwise, Inc. 1999
  14. ^ "Water, Water, Everywhere". WebMD. http://www.webmd.com/balance/features/water-water-everywhere. 
  15. ^ Dr. Mark Dedomenico. "Metabolism Myth #5". MSN Health. http://health.msn.com/blogs/healthy-diet-fit-body-post.aspx?post=1188190. 
  16. ^ "Exercise and Fluid Replacement". American College of Sports Medicine. http://journals.lww.com/acsm-msse/Fulltext/2007/02000/Exercise_and_Fluid_Replacement.22.aspx. 
  17. ^ Nancy Cordes. "Busting The 8-Glasses-A-Day Myth". CBS. http://www.cbsnews.com/stories/2008/04/02/eveningnews/main3991145.shtml. 
  18. ^ ""Drink at Least 8 Glasses of Water a Day" - Really?". Dartmouth Medical School. http://dms.dartmouth.edu/news/2002_h2/08aug2002_water.shtml. 
  19. ^ "Exercise and Fluid Replacement". American College of Sports Medicine. http://journals.lww.com/acsm-msse/Fulltext/2007/02000/Exercise_and_Fluid_Replacement.22.aspx. 

External links


Simple English

Dehydration (hypohydration) means less water in something. The word comes from the ancient Greek word for water, hydor.

When people are dehydrated, they have lost so much water in their body that their bodies no longer work in the right way. Dehydration is a very bad condition and if the problem is not fixed, then the person who is dehydrated can die since they do not have enough water in their bodies.

Causes

Dehydration is most of the time caused by not drinking enough water while exercising a lot. It can also be caused by diseases such as diarrhea and cholera and infections by bacteria that may harm the intestines. Vomiting causes a person to lose a lot of water as well, and this can dehydrate a person. If a person is in a desert area or any place where it is hot, then he or she sweats more and can get dehydration if he or she does not drink a lot of water.

Symptoms

  • Thirst
  • Little/no urination
  • Weakness
  • Less tears
  • Dryness of the mouth
  • Cramps
  • Low blood pressure and high pulse
  • Erectile dysfunction








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